title: The emerging role of targeted therapy in renal cell carcinoma (RCC): is it time for a neoadjuvant or an adjuvant approach?
abstract: OBJECTIVE
  We address whether rational and significant clinical data exist on using angiogenic targeted therapies as neoadjuvant or adjuvant options to nephrectomy in non-metastatic RCC.
  
  
  METHODS
  We reviewed the recent international literature by carrying out a PUBMED search.
  
  
  RESULTS
  Neoadjuvant: a possible indication for a neoadjuvant targeted therapy approach is to facilitate surgery, reducing risks for patients and increasing the possibility of removing the mass and improving oncological results. Adjuvant: three major phase III clinical trials are currently ongoing. The ASSURE trial (1 year on oral sunitinib, sorafenib or placebo), the SORCE trial (3 years on placebo versus 1 year on sorafenib, followed by 2 years on placebo versus 3 years on sorafenib), and the S-TRAC trial (1 year on sunitinib or placebo) analyze patients who are at high risk of relapse.
  
  
  CONCLUSIONS
  Rationale and needs for the neoadjuvant or adjuvant use of targeted therapies in RCC are relevant. Significant phase III trials on the adjuvant use of targeted therapy in RCC are ongoing.
authors.affiliation: Department of Urology "U. Bracci", University Sapienza of Rome, Viale Policlinico 155, 00161 Rome, Italy. sciarra.md@libero.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sciarra
authors.forename: Susanna
authors.initials: S
authors.lastname: Cattarino
authors.forename: Stefano
authors.initials: S
authors.lastname: Salciccia
authors.forename: Andrea
authors.initials: A
authors.lastname: Alfarone
authors.forename: Alessandro
authors.initials: A
authors.lastname: Gentilucci
authors.forename: Ulderico
authors.initials: U
authors.lastname: Parente
authors.forename: Gianna
authors.initials: G
authors.lastname: Mariotti
authors.forename: Michele
authors.initials: M
authors.lastname: Innocenzi
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Gentile
mesh_terms: D002292:Carcinoma, Renal Cell / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy*; D058990:Molecular Targeted Therapy; D020360:Neoadjuvant Therapy; D013997:Time Factors